Provider Demographics
NPI:1992757264
Name:KATZ, JEFFREY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:KATZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12096 NW HALLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8428
Mailing Address - Country:US
Mailing Address - Phone:503-208-4116
Mailing Address - Fax:503-213-6510
Practice Address - Street 1:BEAVERTON MEDICAL OFFICE
Practice Address - Street 2:4855 SW WESTERN AVE
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:971-217-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24537207Q00000X
MN68370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227399Medicaid
P00061508OtherRR PIN
P00061508OtherRR PIN
P00061508OtherRR PIN
116342Medicare ID - Type Unspecified